Michael COSTELLO (Australia)
Michael is gynaecologist with subspecialty certification in Reproductive Endocrinology and Infertility (CREI) whose current positions are with the University of New South Wales, Royal Hospital for Women and IVF Australia in Sydney, Australia. He has a special interest in Polycystic Ovary Syndrome (PCOS) and chaired the “Therapy for Infertility for PCOS” Guideline Development Group (GDG) for the Evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome - the first evidenced based guideline in PCOS, first published in Australia in 2011 and updated in 2015. He then chaired the GDG in the topic area of Screening, Diagnostic Assessment and Management of Infertility in PCOS for the international evidenced-based guideline for the assessment and management of PCOS published in 2018. He is also an editor for the Cochrane Menstrual Disorders & Subfertility Group. He has a strong interest in evidence-based medicine and has published widely including scientific journal papers and book chapters.
Abstract
PCOS 2018 Guideline Explained
Background: The first evidence based international guideline on PCOS was recently published in June 20181 and a summary of the recommendations was later simultaneously co-published in 3 high quality journals 2, 3, 4.
Aims: This guideline aims to optimize the evidence-based, consistent care that meets the needs and improves the quality of life of women with PCOS.
Participants: This guideline was Australian led and involved 63 international multidisciplinary health professional experts and consumer members representing 37 international societies & consumer groups across 71 countries and resulted in 166 recommendations and practice points.
Process: Governance included an international advisory board from six continents, a project board, five guideline development groups, consumer and translation committees. This guideline was Australian led with the Australian Centre for Research Excellence in PCOS (Australian CRE PCOS), funded by the National Health and Medical Research Council (NHMRC) of Australia, partnering with the European Society of Human Reproduction and Embryology (ESHRE) and the American Society for Reproductive Medicine (ASRM). International Society-nominated panels included consumers, paediatrics, endocrinology, gynaecology, primary care, reproductive endocrinology, psychiatry, psychology, dietetics, exercise physiology, public health, project management, evidence synthesis and translation experts.
Evidence: Best practice evidence-based guideline development involved extensive evidence synthesis and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework covered desirable versus undesirable effects of an intervention, evidence quality, feasibility, acceptability, cost, implementation and ultimately recommendation strength.
Conclusions: In the guideline, we endorsed the Rotterdam PCOS diagnostic criteria in adults (two of clinical or biochemical hyperandrogenism, ovulatory dysfunction, or polycystic ovaries on ultrasound) excluding other causes. Where irregular menstrual cycles and hyperandrogenism are present, we highlight that ultrasound is not necessary in diagnosis. In adolescents (within eight years of menarche), both hyperandrogenism and ovulatory dysfunction are required, with ultrasound not recommended. Ultrasound criteria are tightened with advancing technology. Anti-Müllerian hormone levels are not yet adequate for diagnosis. Once diagnosed, assessment and management includes reproductive, metabolic and psychological features. Education, self-empowerment, multidisciplinary care and lifestyle intervention for prevention or management of excess weight are important. Depressive and anxiety symptoms should be screened, assessed and managed with the need for awareness of other impacts on emotional wellbeing. Combined oral contraceptive pills are first-line pharmacological management for menstrual irregularity and hyperandrogenism, with no specific recommended preparations and general preference for lower dose preparations. Metformin is recommended in addition or alone, primarily for metabolic features. Letrozole is first-line pharmacological infertility therapy; with clomiphene and metformin having a role alone and in combination. Gonadotrophins and laparoscopic surgery are second line and in-vitro fertilisation third line in isolated PCOS. Overall evidence is low to moderate quality, requiring significant research expansion in this neglected, yet common condition. Guideline translation will be extensive including a multilingual patient mobile application and health professional training.
References:
- Helena Teede, Marie Misso, Michael Costello, Anuja Dokras, Joop Laven, Lisa Moran, Terhi Piltonen and Robert Norman on behalf of the International PCOS Network in collaboration with funding, partner and collaborating organisations. International evidence based guideline for the assessment and management of polycystic ovary syndrome. Copyright Monash University, Melbourne 2018.
- Helena J. Teede, Marie L. Misso, Michael F Costello, Anuja Dokras, Joop Laven, , Lisa Moran, Terhi Piltonen, Robert.J. Norman on behalf of the International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility 2018; 110 (3): 364-379.
- Helena J. Teede, Marie L. Misso, Michael F Costello, Anuja Dokras, Joop Laven, , Lisa Moran, Terhi Piltonen, Robert.J. Norman on behalf of the International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clinical Endocrinology 2018; 1-18; DOI: 10.1111/cen.13795.
- Helena J. Teede, Marie L. Misso, Michael F Costello, Anuja Dokras, Joop Laven, , Lisa Moran, Terhi Piltonen, Robert.J. Norman on behalf of the International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Human Reproduction 2018; 33(9): 1602-1618.